February 14, 2017 | Author: bh007patel | Category: N/A
Form
Additional personal particulars information
1221
About this form
Please use a pen, and write neatly in English using BLOCK LETTERS.
This is a supplementary form required to support your visa application and is to be completed by all applicants who are 18 years of age or over.
Tick where applicable
Important – Please read this information carefully before you complete this form. Once you have completed this form we strongly advise that you keep a copy for your records.
Part A – Your details 1
Integrity of application The Department of Immigration and Citizenship (the department) is committed to maintaining the integrity of the visa and citizenship programs. Please be aware that if you provide us with fraudulent documents or claims, this may result in processing delays and possibly your application being refused.
The information provided might also be disclosed to agencies who are authorised to receive information. The information form 993i Safeguarding your personal information, available from offices of the department, gives details of agencies to which your information might be disclosed.
Home page www.immi.gov.au General Telephone 131 881 during business hours enquiry line in Australia to speak to an operator (recorded information available outside these hours). If you are outside Australia, please contact your nearest Australian mission.
Your full name (as shown in your passport or travel document) Family name
Patel
Given names
Bhaul
2
Other names you are, or have been, known by (including name at birth, previous married names, aliases)
3
Name in your own language or script (if applicable). Please write Chinese names in Chinese Commercial Code Numbers
4
Date of birth
5
Place of birth
About the information you give The department is authorised to collect information provided on this form under Part 2 of the Migration Act 1958 ‘Control of Arrival and Presence of Non-Citizens’. The information provided will be used for assessing your eligibility for a visa to travel, enter and remain in Australia and other purposes relating to the administration of the Migration Act, for example, to assist migrants with settling in Australia or for ensuring compliance with the Migration Act.
DAY
YEAR
Town/City
Hirpura, Vijapur, Mehsana
Country
India Male ✔
6
Sex
7
Relationship status
Female
Married ✔
8
MONTH
14-Apr-1982
Separated
Engaged
Divorced
De facto
Widowed
Never married or been in a de facto relationship
Citizenship or nationality (give details of all held)
Indian DAY
MONTH
Date granted
14-Apr-1982
Place granted
India
© COMMONWEALTH OF AUSTRALIA, 2009
YEAR
1221 (Design date 07/09) - Page 1
9
Your current residential address (a post office box address is not acceptable as a residential address)
13/28, Westbury St St Kilda East
VIC
POSTCODE
3183
Part B – Travel details 14 Details from your passport Passport number
E0541903
Country of passport
India DAY
10 Address for correspondence (if the same as your residential address, write ‘AS ABOVE’)
11 Your residential address in Australia (if known)
YEAR
Date of issue
26-Dec-2001
Date of expiry
25-Dec-2011
Issuing authority/ Place of issue as shown in your passport
POSTCODE
MONTH
Ahmedabad
15 Other travel document details
13/28, Westbury st St Kilda East VIC
POSTCODE
3183
12 Your contact details COUNTRY CODE
AREA CODE
16 Are you applying for a visa to travel to Australia as a:
NUMBER
Office hours
(
)
(
)
0430459933
After hours
(
)
(
)
0430459933
Fax number
(
)
(
)
E-mail addresses
[email protected]
migrant/refugee
temporary resident
visitor
student/academic
OR Are you applying for: protection
permanent residency a further temporary stay ✔
If insufficient space give details at Question 43
17 Visa subclass you are applying for 13 Do you agree to the department communicating with you by fax, e-mail or other electronic means? No Yes ✔
485
18 What is the general purpose of your journey/further stay? Give details COUNTRY CODE
AREA CODE
NUMBER
Fax number
(
E-mail address
[email protected]
)
(
)
During the temporary resident period, I will try to find out the job in my field as well study the professional year program which help me to develop my future career.
19 If you are outside Australia, give details of your intended arrival DAY
MONTH
YEAR
Date of arrival Flight/Ship details
20 How long do you intend to stay in Australia? DAY
From
1221 (Design date 07/09) - Page 2
© COMMONWEALTH OF AUSTRALIA, 2009
MONTH
01-Jun-2010
YEAR
DAY
to
MONTH
31-Dec-2012
YEAR
21 Give details of each place you intend to stay in Australia, including the length and purpose of each stay
Part C – Employment details 23 Give details of your employment for the last 5 years
1. Place you intend to stay
(list your most recent experience first)
Melbourne
DAY
Purpose of stay
1. From
MONTH
YEAR
01-Dec-2008
DAY
to
MONTH
YEAR
18/05/2010
Name of employer
Further study + Job
Borgcraft Pty Ltd DAY
From
MONTH
YEAR
DAY
to
01-Jun-2010
MONTH
Employer’s address
YEAR
31-Dec-2012
31-33, Slough Rd Altona
2. Place you intend to stay
VIC
POSTCODE
3018
Type of business
Purpose of stay
Pastry manufacturing Occupation/Position
Process worker DAY
MONTH
YEAR
DAY
From
MONTH
YEAR
Duties
to
Pick-packing, general cleaning, lifting 3. Place you intend to stay DAY
Purpose of stay
2. From
MONTH
YEAR
01-Jun-2009
DAY
to
MONTH
YEAR
18-May-2010
Name of employer
Drake International DAY
MONTH
YEAR
DAY
From
MONTH
YEAR
Employer’s address
to
479, Warrigal Rd
Moorabbin
4. Place you intend to stay
POSTCODE
Purpose of stay
Type of business
Employment Agency Occupation/Position DAY
MONTH
YEAR
DAY
From
MONTH
On-call casual stock taker
YEAR
to
Duties
If insufficient space give details at Question 43
RF Scanning, Stock moving
22 Are you funding your trip? No
Give details of the person/institution funding your trip
DAY
3. From
Full name
MONTH
YEAR
01-May-2008
DAY
to
MONTH
YEAR
18-May-2010
Name of employer
Peter Rowland Catering Pty ltd
Name of institution (if applicable)
Employer’s address
8, River st
Address
South Yarra VIC
Catering
Telephone number (
)
AREA CODE (
3141
Type of business
POSTCODE
COUNTRY CODE
POSTCODE
NUMBER
Occupation/Position
)
On-call casual Stacker
Yes ✔
Duties
Filling of drinks,spirits bottles
© COMMONWEALTH OF AUSTRALIA, 2009
1221 (Design date 07/09) - Page 3
DAY
4. From
MONTH
YEAR
01-Jun-2008
DAY
MONTH
YEAR
3. Institution and city
18-May-2010
to
Name of employer
GTE Workplacement
Qualification
Employer’s address
4/20, Commercial road
Main subjects or duties
Melbourne
VIC
POSTCODE
3004
Type of business
Year of award
Employment Agency Occupation/Position
On-call Casual Stock-taker
4. Institution and city
Duties
RF scanning Qualification
If insufficient space give details at Question 43 Main subjects or duties
Part D – Education and trade qualifications
Year of award
24 Give details of all post secondary qualifications (list your most recent experience first)
If insufficient space give details at Question 43
1. Institution and city
25 Describe any workshops, training, conferences or seminars you have
Swinburne University of Technology
attended in the last 2 years
In the final semester of my post-graduation, i am the part of team who developed a website related project for the Inform Financial Group. Also, we have updated their existing website.
Qualification
M.I.T(Professional computing) Main subjects or duties
Information System & Project Managment, Database, sql-oracle, SAP Year of award
2009 2. Institution and city
Shree U.V.Patel College of Engg Qualification
B.E.I.T
26 List all titles and describe any previous academic or research papers you have had published
Main subjects or duties
c, c++, database, Software Engg Year of award
2004
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© COMMONWEALTH OF AUSTRALIA, 2009
Part E – Details of your personal contact in Australia
Part G – Visitor visa 33 Do you intend to do a course of study while in Australia?
27 Do you have a personal contact in Australia (eg. your sponsor, the person
No
you will be staying with, the person funding your holiday, a family relative or an educational institution)?
Yes
No
Go to Part F
Yes ✔
Family name
Give details
Name of course Name of the institution
Patel Given names
Type of course
Jigar
DAY
28 Date of birth of
MONTH
Part H– Business visas
YEAR
26-Jan-1982
personal contact
34 Intended employment details 29 Current residential address of your personal contact (a post office box address is not acceptable as a residential address)
Name of employer
13/28, Westbury st Employer’s address
St Kilda East VIC
POSTCODE
3183
30 Personal contact’s telephone numbers COUNTRY CODE
POSTCODE
AREA CODE
Type of business
NUMBER
Office hours
(
)
(
)
0425112782
After hours
(
)
(
)
0425112782
Occupation/Position
31 Personal contact’s current employment details
Duties
Name of employer
AHS Hospitality Employer’s address
Level 3, 255
35 Will your intended business activity in Australia require you to visit more
Burke st
than one place of work?
Melbourne, VIC
POSTCODE
3000
No
Type of business
Yes
Hospitality Employment agency Occupation/Position
List the name and location of institutions you will visit during your stay in Australia, the type of business each institution does and the name of your contact at each institution
Room attendent Duties
cleaning, dusting, moping
Part F – Details of your journey to Australia 32 Only complete the section(s) relevant to you If you:
during your stay in Australia?
have applied for a Visitor visa
Go to Part G
have applied for a Business visa
Go to Part H
have applied for a Migration visa ✔
Go to Part I
are a student, academic, researcher or fellow
36 Do you intend to inspect and/or negotiate the purchase of any equipment No Yes
Give details
Go to Part J © COMMONWEALTH OF AUSTRALIA, 2009
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Part I – Migration visas
Part J – Student/Academic/Researcher/Fellows
37 Where do you intend to live?
40 Give details of your thesis topic and research to be undertaken
Melbourne
Town/City
State/Territory Victoria
38 Do you intend to do a course of study while in Australia? No Yes ✔
If you have organised your course, give details below
Name of course
Professional year of Program Name of the institution
Navitaas Type of course
39 Do you intend to work in Australia? No Yes
If you have organised your employment, give details below
Name of employer
Employer’s address
POSTCODE
Type of business Occupation/Position Duties
41 Do you intend to work in Australia? No Yes
If you have organised your employment, give details below
Name of employer
Employer’s address
POSTCODE
Type of business Occupation/Position Duties
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© COMMONWEALTH OF AUSTRALIA, 2009
Part K – Additional information
Part L – Declaration
42 Have you ever been denied or refused a visa or entry
WARNING: Giving false or misleading information is a serious offence.
to another country?
44 I declare that:
No ✔ Yes
• the information I have supplied in this application is complete, correct and up-to-date in every detail; and • I have read and understood the information supplied to me.
Give details
43 Are there any other details you would like taken into consideration? Question number
Signature of applicant DAY
Additional information
MONTH
YEAR
Date 18-May-2010
We strongly advise that you keep a copy of this form and all attachments for your records.
© COMMONWEALTH OF AUSTRALIA, 2009
1221 (Design date 07/09) - Page 7
